Clinics and Practice最新文献

{"title":"Eleven-Year Incidence of Salivary Gland Tumors-A Retrospective, Single-Centered Study in Croatia.","authors":"Anđela Modrić, Mirko Gabelica, Ante Mihovilović, Stipe Dumančić, Ana Dunatov Huljev, Ivana Medvedec Mikić","doi":"10.3390/clinpract15060104","DOIUrl":"10.3390/clinpract15060104","url":null,"abstract":"<p><strong>Background/objectives: </strong>The purpose of this study was to determine the incidence of salivary gland tumors based on age, gender, histological type, and localization over an eleven-year period at the University Hospital of Split.</p><p><strong>Methods: </strong>The medical records of the Department of Otorhinolaryngology with Head and Neck Surgery and the Department of Maxillofacial Surgery at the University Hospital of Split regarding salivary gland tumors were searched from January 2012 to December 2022. The current fifth World Health Organization (WHO) Classification of Head and Neck Tumors and its criteria were considered during that process.</p><p><strong>Results: </strong>Out of 404 patients, 211 (52.20%) were female and 193 (47.77%) male. The mean age was 60. There were four pediatric patients. Six patients had a combination of two different histological types of salivary gland tumors present simultaneously at the exact localization. Therefore, there were 410 histological types in total, 214 related to females and 196 to males. A total of 361 (88.05%) benign and 49 (11.95%) malignant primary salivary gland tumors were detected. The parotid gland was the predominant location (<i>N</i> = 361, 87.8%). There were no cases affecting the sublingual gland. Pleomorphic adenoma was the most common benign histological type (<i>N</i> = 169, 41.2%). The most common malignant histological types were adenoid cystic carcinoma (<i>N</i> = 9, 2.2%) and mucoepidermoid carcinoma (<i>N</i> = 9, 2.2%). The average incidences of salivary gland tumors in the 11 years for the four Dalmatian counties and the Republic of Croatia were 4.45/100,000 and 0.9/100,000, respectively.</p><p><strong>Conclusions: </strong>The results of this study, primarily the ones concerning histological types and localization, do not deviate from general knowledge about salivary gland tumors. Simultaneous and ipsilateral occurrence of different histological types is a rare and extremely valuable finding. The average incidence for Dalmatian counties and the Republic of Croatia is within the range of the International Agency for Research on Cancer estimates.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Where Do We Stand in the Management of Rheumatoid Arthritis Ahead of EULAR/ACR 2025?","authors":"Adriana Liliana Vlad, Corina Popazu, Alina-Maria Lescai, Doina Carina Voinescu, Alexia Anastasia Ștefania Baltă","doi":"10.3390/clinpract15060103","DOIUrl":"10.3390/clinpract15060103","url":null,"abstract":"<p><p><b>Background</b>: Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by systemic inflammation and the progressive damage of joints, significantly impacting patients' quality of life. Managing this condition requires a complex approach that integrates pharmacological and non-pharmacological therapies, alongside psychosocial support and patient education. Aim: This study aims to highlight the importance of an interdisciplinary approach in the treatment of rheumatoid arthritis, focusing on the role of pharmacological therapies, monitoring treatment response, and the involvement of a multidisciplinary team in the effective management of the disease. <b>Methods</b>: The analysis was based on a review of the specialised literature concerning the role of disease-modifying antirheumatic drugs (DMARDs, both conventional and biological), the use of inflammatory markers (CRP and ESR), advanced imaging techniques, and the contribution of various medical specialities to the holistic management of rheumatoid arthritis. A total of 595,900 records were identified, of which 53 studies were ultimately included in the detailed analysis. Relevant studies from fields such as rheumatology, nutrition, psychology, and physical therapy were included. <b>Results</b>: The findings underline that DMARDs, in combination with other pharmacological therapies, remain essential for slowing disease progression. Monitoring treatment response through inflammatory markers and imaging techniques allows for the adjustment of therapeutic strategies and the prevention of complications. An interdisciplinary approach, involving the rheumatologist, general practitioner, physiotherapist, nutritionist, and psychologist, provides significant benefits, such as reducing inflammation, improving joint function, and offering psychosocial support. <b>Conclusions</b>: The effective management of rheumatoid arthritis requires a personalised interdisciplinary approach. Integrating various specialities, along with patient education and psychosocial support, contributes to better disease management, the prevention of disabilities, and improved quality of life. This review is not registered.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192006/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Bowel Evisceration Through Umbilical Hernia Sites in Adult Patients: A Systematic Review of the Literature.","authors":"Simone Gianazza, Niccolò Grappolini, Marika Morabito, Andrea Palillo, Marta Ripamonti, Davide Inversini","doi":"10.3390/clinpract15060099","DOIUrl":"10.3390/clinpract15060099","url":null,"abstract":"<p><strong>Background: </strong>The literature reports few instances of spontaneous bowel eviscerations through umbilical hernia sites. Spontaneous rupture of the hernia sac is a less common complication, primarily associated with persistent ascites or congenital wall defects.</p><p><strong>Materials and methods: </strong>A systematic review was conducted using the PubMed database-the United States National Library of Medicine, with the search terms \"spontaneous bowel evisceration\" and \"umbilical hernia evisceration\". However, several results were deemed unsuitable for this manuscript. From a total of 185 cases, this review was narrowed down to 9 usable reports. Non-English language cases, duplicates, and cases unrelated to the pathology, including pediatrics, malformations, herniation through other organs, and animal cases, were excluded.</p><p><strong>Conclusions: </strong>Spontaneous evisceration in a hernia is an uncommon yet serious condition. A major risk factor appears to be underlying liver disease with its complications, such as ascites, chronic malnutrition with hypoalbuminemia, and collateral circulation formation. These factors contribute to the susceptibility of the sac and the hernia wall to rupture. However, the limited number of reported cases precludes the establishment of a preferred treatment approach. In the acute phase, the use of prosthetics may be less advisable, but in an elective setting, the cirrhotic patient could be offered repair.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Maternal Vitamin D Deficiency and the Risk of Placental Abruption: A Cross-Sectional Study in a Greek Obstetric Population.","authors":"Artemisia Kokkinari, Evangelia Antoniou, Eirini Orovou, Maria Dagla, Maria Tzitiridou-Chatzopoulou, Antigoni Sarantaki, Kleanthi Gourounti, Georgios Iatrakis","doi":"10.3390/clinpract15060102","DOIUrl":"10.3390/clinpract15060102","url":null,"abstract":"<p><strong>Background: </strong>Vitamin D deficiency (VDD) during pregnancy has been associated with various obstetric complications, including preeclampsia, gestational diabetes, and premature rupture of membranes. However, its potential link to placental abruption remains underexplored. The aim of this study was to investigate whether low maternal vitamin D levels are associated with an increased risk of placental abruption in pregnancies considered otherwise low-risk.</p><p><strong>Methods: </strong>We conducted a cross-sectional study involving 248 pregnant women who were admitted for delivery at a public hospital in Athens, Greece. Serum levels of 25-hydroxyvitamin D [25(OH)D] were measured upon admission. Levels below 30 ng/mL were classified as insufficient. Although this threshold corresponds to insufficiency according to the Endocrine Society, for the purposes of this study, levels < 30 ng/mL were treated as indicative of vitamin D deficiency in order to capture broader physiological implications. Cases of placental abruption were identified based on obstetric history and clinical documentation at the time of delivery. A Chi-square test was used to assess the association between vitamin D status and placental abruption, and a multivariate logistic regression model was applied to control for potential confounders, including hypertensive disorders of pregnancy, smoking, and preterm birth. The potential role of vitamin D supplementation during pregnancy was also explored as part of the analysis.</p><p><strong>Results: </strong>Our analysis revealed that women with VDD had a significantly higher incidence of placental abruption (<i>p</i> < 0.05). In the multivariate model, VDD remained an independent risk factor (adjusted OR: 3.2, 95% CI: 1.1-9.6). Additional risk factors that showed significant associations with placental abruption included pregnancy-induced hypertension and maternal smoking.</p><p><strong>Conclusions: </strong>These findings support the hypothesis that insufficient maternal vitamin D levels may contribute to adverse pregnancy outcomes, including placental abruption. Further prospective studies are warranted to clarify the causal mechanisms and to evaluate whether early detection and correction of vitamin D deficiency could serve as a preventive strategy in prenatal care.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising Threats and Evolving Trends: Five Years of Urinary Tract Infection Prevalence in a Portuguese Hospital.","authors":"Francisco José Barbas Rodrigues, Patrícia Coelho, Sónia Mateus, Miguel Castelo-Branco","doi":"10.3390/clinpract15060100","DOIUrl":"10.3390/clinpract15060100","url":null,"abstract":"<p><p><b>Background/Objective:</b> Urinary tract infections (UTIs) are a significant public health concern worldwide, yet longitudinal data from Portuguese hospital settings remain limited. This study aimed to characterize epidemiological trends, microbial etiology, antimicrobial resistance patterns, and associated risk factors of UTIs over a five-year period (2018-2022) in a central Portuguese hospital. <b>Methods:</b> In this retrospective observational study, 23,682 positive urine cultures were analyzed from specimens collected between January 2018 and December 2022. Data were extracted from the laboratory information system and included patient demographics, clinical service of origin, isolated microorganisms, resistance profiles, and annual antibiotic consumption (Defined Daily Dose (DDD) per 1000 patient-days). UTI prevalence was calculated as the proportion of positive cultures among all urine samples processed annually. <b>Results:</b> The positivity rate increased from 18.7% in 2018 to 22.7% in 2022, with a peak in 2019. Women represented around 70% of cases throughout the study period. Most infections originated from inpatient wards, followed by emergency services. <i>Escherichia coli</i> remained the leading pathogen (≈62%), followed by <i>Klebsiella pneumoniae</i> (≈14%) and <i>Enterococcus faecalis</i> (≈8%). Risk factors included catheterization (37.2%), prior UTI history (22.1%), and diabetes mellitus (18.5%). Longer hospital stays (>7 days) were associated with increased positivity. For <i>E. coli</i>, resistance ranged from 2% (amikacin) to 41% (ampicillin), with increasing resistance to ertapenem and fosfomycin and decreasing resistance to several key antibiotics. <i>K. pneumoniae</i> showed 4-36% resistance across antimicrobials, with notable increases for fosfomycin, meropenem, and cefuroxime axetil. Antibiotic usage trends reflected these patterns, with declining use of amikacin and rising use of cefuroxime axetil and meropenem. <b>Conclusions:</b> Over the five-year period, both UTI prevalence and resistance to critical antimicrobials increased, reinforcing the need to update empirical treatment guidelines. Identified risk factors may inform targeted prevention strategies. Ongoing surveillance and antimicrobial stewardship are crucial to mitigate the rising burden of UTIs and resistance.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12192032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unicortical Locking Screws Provide Comparable Rigidity to Bicortical Compression Screws in Tranverse Mid-Shaft Clavicle Fracture Plate Fixation Constructs.","authors":"Curtis W Hartman, Nicholas C Branting, Matthew A Mormino, Timothy J Lackner, Bradford P Zitsch, Edward V Fehringer, Hani Haider","doi":"10.3390/clinpract15060101","DOIUrl":"10.3390/clinpract15060101","url":null,"abstract":"<p><p><b>Background</b>: Mid-shaft clavicle fracture fixation carries neurovascular injury risk. The purpose of this study was to compare bicortical compression and unicortical locked clavicle plate constructs biomechanically. <b>Materials and Methods</b>: Ten fourth-generation composite transverse mid-shaft clavicle osteotomy specimens were assigned to two groups, and each clavicle was fixed with an eight-hole second-generation 3.5 mm pelvic reconstruction plate placed superiorly. Group one included five fixed with bicortical compression screws and group two included five fixed with unicortical locking screws. All were tested on a four-axis servohydraulic testing frame in three modes: axial rotation, anterior/posterior bending, and cephalad/caudad bending. <b>Results</b>: Mean construct stiffness for AP bending was 1.255 ± 0.058 Nm/deg (group 1) and 1.442 ± 0.065 Nm/deg (group 2) (<i>p</i> = 0.001). Mean construct stiffness for axial rotation was 0.701 ± 0.08 Nm/deg (1) and 0.726 ± 0.03 Nm/deg (2) (<i>p</i> = 0.581). Mean construct stiffness for cephalad bending was 0.889 ± 0.064 Nm/deg (1) and 0.880 ± 0.044 Nm/deg (2) (<i>p</i> = 0.807). Mean construct stiffness for caudal bending was 2.523 ± 0.29 Nm/deg (1) and 2.774 ± 0.25 Nm/deg (2) (<i>p</i> = 0.182). <b>Conclusions</b>: With transverse mid-shaft clavicle fractures, unicortical locking fixation provided comparable rigidity to bicortical compression fixation in axial rotation, cephalad bending, and caudal bending; it provided greater rigidity in AP bending.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191496/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Online Occupational Therapy as a Rehabilitation Intervention for Parkinson's Disease: A Systematized Review.","authors":"Antigoni Kountoura, Thomas Tegos, Marianthi Arnaoutoglou, Magdalini Tsolaki","doi":"10.3390/clinpract15060098","DOIUrl":"10.3390/clinpract15060098","url":null,"abstract":"<p><p><b>Background/Objectives:</b> Occupational therapy (OT) plays a crucial role in addressing functional limitations and promoting independence in Parkinson's disease (PD) patients. OT interventions target motor skills, daily activities, and engagement in meaningful tasks. Telehealth, the remote delivery of healthcare services, has expanded access to rehabilitation, including OT for PD. While several studies have examined the benefits of online OT, a comprehensive assessment of its impact on functional outcomes and quality of life (QoL) is needed. This review aimed to evaluate the effects of online OT interventions on functional outcomes and QoL of patients with PD. <b>Methods</b>: This review employed a systematized approach, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, though it did not constitute a full systematic review or meta-analysis. A comprehensive search was conducted across PubMed, Web of Science, Scopus, and Embase databases between August 2023 and September 2024. The search targeted randomized controlled trials (RCTs) investigating telerehabilitation interventions in OT for individuals with PD. Studies were excluded if they were not published in English, did not employ an RCT design, or lacked a focus on telerehabilitation within the scope of occupational therapy for PD. Additionally, systematic reviews, meta-analyses, qualitative studies, and studies without measurable outcomes were excluded. Nine studies met the inclusion criteria, with four involving occupational therapists directly and five evaluating interventions within the scope of OT practice. <b>Results</b>: The primary outcomes of this review focused on mobility improvements in PD patients, assessed through gait metrics such as gait speed, stride length, and gait variability. Secondary outcomes evaluated the impact of telerehabilitation on QoL, using tools such as the Parkinson's Disease Questionnaire (PDQ-39) and other disease-specific instruments. The findings demonstrated that online OT interventions significantly improved motor skills, cognitive function, and activities of daily living in PD patients. Furthermore, these interventions enhanced overall well-being and QoL. The remote format fostered sustained engagement and adherence to therapy, contributing to better long-term outcomes. <b>Conclusions</b>: Online OT interventions show promising potential for improving functional outcomes and QoL in PD patients. These findings underscore the potential of telehealth to expand access to OT services, thereby enhancing long-term rehabilitation outcomes for this population.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Impact of Community-Based Medical Education on Health Literacy and Patient Empowerment in Underserved Populations: A Pilot Cohort Study.","authors":"Aida Aljafri, Persia Abba, Anita Sedghi, Andreas Conte, Waseem Jerjes","doi":"10.3390/clinpract15060097","DOIUrl":"10.3390/clinpract15060097","url":null,"abstract":"<p><p><b>Background:</b> Traditionally, community-based education (CBE) programmes have been utilised for teaching medical students clinical and interpersonal skills through placement in underserved environments. This pilot cohort study tested an extended model of CBE by infusing patient education into student-conducted consultations with the dual objectives of stimulating improved learning for the students and improved health literacy for the patients. <b>Methods:</b> The intervention involved 38 final-year medical students and 85 adult patients and from underprivileged communities in North West London. The students first undertook online preparatory workshops on health literacy, communication skills, and cultural competence. Subsequently, they imparted 20-30 min educational sessions on chronic disease management and preventive care to the patients on their clinical placements. The quantitative measurement used pre- and post-intervention questionnaires, and the qualitative measurement was based on reflective diaries and patient feedback. Paired <i>t</i>-tests were used for statistical comparisons, while a thematic analysis was used for textual answers. <b>Results:</b> Student confidence in breaking down medical jargon improved from 2.8 ± 0.7 to 4.4 ± 0.5 (<i>p</i> < 0.01), and confidence in making use of visual aids improved from 2.5 ± 0.8 to 4.2 ± 0.6 (<i>p</i> < 0.01). Understanding among the patients of their health conditions improved from 27% to 74% (<i>p</i> < 0.001), and self-confidence in their ability to manage their health improved from 31% to 79% (<i>p</i> < 0.001). The qualitative feedback noted improved empathy, cultural sensitivity, and a positive effect on patient empowerment through tailored education. <b>Conclusions:</b> This CBE intervention had two benefits: improving teaching and communication skills in students and greatly enhancing health literacy in underserved patients. The integration of structured education into usual care encounters holds the promise of a scalable, sustainable method for addressing health disparities. Longer longitudinal studies are necessary to assess its long-term success and incorporation into medical education.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 6","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12191660/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144486569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-Articular Injection of Bupivacaine and Adrenaline Reduces Intraoperative and Postoperative Blood Loss in Total Knee Arthroplasty: A Retrospective Case-Control Study.","authors":"Ahmad Biadsi, Mor Bracha Akselrad, David Segal, Shanny Gur, Michael Markushevich, Yaron Shraga Brin","doi":"10.3390/clinpract15050096","DOIUrl":"10.3390/clinpract15050096","url":null,"abstract":"<p><p><b>Objective</b>: To evaluate the effect of preoperative intra-articular injection of bupivacaine and adrenaline (BAD) on blood loss and postoperative hemoglobin levels in primary total knee replacement. <b>Methods</b>: We retrospectively assessed 38 consecutive patients who underwent primary total knee arthroplasty at our institution between 2018 and 2019, as performed by two chief orthopedic surgeons. The study group included 22 patients who received an intra-articular injection of 40 mL solution of BAD 0.25% preoperatively. The control group included 16 patients who did not receive the BAD injection preoperatively. Both groups received an IV tranexamic acid (TXA) 1 g treatment prior to the first incision. The posterior capsule and soft tissues were infiltrated after femoral chamfer cuts with a 60 mL BAD solution in both groups. Blood loss was evaluated in all patients by measuring the volume collected in the suction container before the first irrigation and prior to cementation. Additional assessments included the volume of blood drained during the first 24 h postoperatively, as well as changes in hemoglobin levels (delta hemoglobin) 24 h after surgery and at hospital discharge. <b>Results</b>: The study and the control groups were similar in age, sex, demographics, and comorbidities. The mean patient age was 71.4 ± 6.5 in the injected group and 70.6 ± 7.5 in the control group. The volume of blood suctioned during surgery was significantly lower in the study group compared to the control group (201 ± 84.3 mL vs. 261.25 ± 83.3 mL; <i>p</i> = 0.04). Similarly, the amount of blood drained within the first 24 h postoperatively was also reduced in the study group (204.3 ± 91.1 mL vs. 363.44 ± 131.9 mL; <i>p</i> = 0.0001). Ultimately, the decrease in hemoglobin levels from baseline to discharge was less pronounced in the study group compared to the control group (1.7 ± 0.9 g/dL vs. 2.44 ± 1.3 g/dL; <i>p</i> = 0.038). <b>Conclusions:</b> Intra-articular injection of 40 mL bupivacaine and 0.25% adrenaline solution before skin incision may reduce intraoperative and postoperative blood loss among patients undergoing total knee arthroplasty.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Diabetes and Vertical Bone Defects in Periodontitis Using Cone Beam Computed Tomography: A Cross-Sectional Study in the Eastern Province, Saudi Arabia.","authors":"Eman Aljoghaiman, Abdullah Alzahrani, Rakan Albarqi, Saad Alqbbani, Hamad Alshiddi, Mishali AlSharief, Mohammed Alsaati, Faisal E Al Jofi","doi":"10.3390/clinpract15050095","DOIUrl":"10.3390/clinpract15050095","url":null,"abstract":"<p><p><b>Background</b>: The association between diabetes and periodontal disease is well established, but its impact on intrabony periodontal defects remains unclear. Aims: This study examines the relationship between diabetes and intrabony periodontal defects using cone beam computed tomography (CBCT). <b>Methods:</b> A retrospective analysis of 99 CBCT images from Imam Abdurrahman bin Faisal University (2010-2022) was conducted. Intrabony periodontal defects were assessed, and logistic regression was used to analyze their association with diabetes. <b>Results</b>: Intrabony periodontal defects were detected in 66% of the sample, with 36% exhibiting multiple defects. Crude logistic regression showed a significant association between diabetes and intrabony periodontal defects (OR 3.986, 95% CI 1.454-10.922) and defect count (OR 3.382, 95% CI 1.430-8.003). However, multiple regression analysis did not confirm diabetes as an independent predictor (adjusted OR 0.740, 95% CI 0.087-6.314). <b>Conclusions:</b> Diabetes was not significantly associated with the prevalence or number of intrabony periodontal defects after adjusting for the confounders. However, these findings highlight the multifactorial nature of periodontal bone loss and the need for comprehensive patient assessment. Clinically, this underscores the importance of integrating both systemic and local periodontal evaluations in diabetic patients to improve early detection and personalized treatment planning. Further research with larger, more diverse samples and integrated clinical assessments is needed to refine our understanding of this relationship and enhance patient management.</p>","PeriodicalId":45306,"journal":{"name":"Clinics and Practice","volume":"15 5","pages":""},"PeriodicalIF":1.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12110205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}